I think we need to revisit the role of lactoferrin in controlling candida and GERD.Some studies say that it normalizes iron levels removing some when there is too much and stabalizing the amount of iron.


"Examples of specific bacteria inhibited by lactoferrin include: Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Helicobacter pylori, all of which are capable of causing serious illness. While many studies have involved observations of lactoferrin's effects on microbial growth in a laboratory dish or test tube, recent research in Japan has demonstrated that, when administered orally to mice, bovine-derived lactoferrin causes a marked reduction in the proliferation of intestinal bacteria, including several strains of the pathogenic bacterium, Clostridium. Furthermore, when administered to laboratory animals, lactoferrin also decreases the number of bacteria that translocate, or pass through, the cell lining of the intestines. Translocation of bacteria through the intestinal epithelium is a means by which bacteria can gain access to the blood and lymphatic system, and, if they are not checked by the body's immune system, infections and illness ensue
As mentioned previously, lactoferrin also inhibits several species of fungi and certain parasites. Fungi inhibited by lactoferrin include Candida albicans, the form of yeast normally present to some extent in all individuals, but responsible for 'yeast infections,' or aggressive fungal overgrowth. The mechanism by which lactoferrin inhibits some parasites maybe via stimulation of the process of phagocytosis, whereby immune cells engulf and digest foreign organisms.
http://intelegen.com/ImmuneSystem/lactoferrin.htm



"When fed to adult animals and human infants, lactoferrin showed a dramatic increase in good micro flora—such as bifidus—and a decrease in bad bacteria, such as E. coli, streptococcus, clostridium and others..
Some research also suggests that lactoferrin is able to stimulate intestinal cell growth and may lead to better digestive functions, in addition to its ability to enhance the growth of “good” microflora in the intestine."
http://www.lef.org/magazine/mag2000/oct2000_report_lactoferrin.html



"Most milk allergies are caused by an allergy to whey protein, the most abundant milk protein, or lactose, the most abundant milk sugar. Lactoferrin, on the other hand, is a very minor component of milk, and it is very unlikely that your child will be allergic to lactoferrin."
http://eu-es.facebook.com/topic.php?uid=54858283139&topic=8049



"C. krusei being more sensitive to lactoferrin (c 1.4 times) than C. albicans. All 20 oral isolates of C. krusei were susceptible to lactoferrin."
http://www.ncbi.nlm.nih.gov/pubmed/9393559



"Five oral isolates each of Candida albicans and Candida krusei were studied for their sensitivity to the fungicidal effect of human lactoferrin. Significant inter- and intraspecies variations were observed and with most isolates the sensitivity of C. krusei to lactoferrin was greater than that of C. albicans. Fungicidal activity of lactoferrin was dose-dependent and observable only with the irondashfree form of the molecule (apo-lactoferrin). Irondashsaturated lactoferrin was ineffective against all isolates.
http://www.ncbi.nlm.nih.gov/pubmed/8141667



"Thus, BLF was fungicidal for the six Candida species in the following decreasing order, C. tropicalis > C. krusei > C. albicans > C. guilliermondii > C. parapsilosis > C. glabrata; the latter being the most resistant."
http://www.ncbi.nlm.nih.gov/pubmed/10200932



"Only iron free apo-lactoferrin was effective in inhibiting Candida in this study. Lactoferrin prevented Candida turning hyphal (in absence of iron). Effective for a number of isolates of C. albicans, krusei and tropicalis."
http://scialert.net/pdfs/pjbs/2009/91-94.pdf



"In this study, bovine holo-lactoferrin, but not apo-lactoferrin stimulated L. Acidophilus. Both forms of lactoferrin increased numbers of B. breve, B. infantis and B. bifidum, but neither affected B. longum."
http://www.ncbi.nlm.nih.gov/pubmed/15222478



"Lactoferrin, an iron-binding protein, is a vital element to the human body in that it is specifically utilized to retrieve iron from the foods we ingest, and then deliver the iron wherever it is needed by the body.
On the other hand, when iron is carried through the body by lactoferrin, as it is meant to be, greater than 95% of it is assimilable. The lactoferrin carries the iron directly to the specific receptor sites in the body where iron is meant to be absorbed and utilized. And because it is attached to lactoferrin, the iron cannot be absorbed and utilized by the bacteria, viruses, yeasts and other harmful parasites that require it for their metabolism. These harmful organisms are simply unable to capture and utilize iron in the presence of lactoferrin!"
http://www.upwardquest.com/nutrition.b-lymphocytes.html



"A study published in July 2009 examined the effects of lactoferrin versus an iron supplement (ferrous sulfate) in a group of pregnant women with anemia. This is an especially sensitive population. The risk of digestive complications and the added importance of adherence to treatment is particularly important during this time. 100 expectant mothers participated in the study. Half received 100 mg of lactoferrin twice daily, while the remainder were given 520 mg of ferrous sulfate once a day (providing about 100 mg of actual iron). (4) After 30 days of treatment, both groups demonstrated similar increases in serum ferritin, hemoglobin and iron.
An Italian experiment from 2006 supports these current findings. That study followed 300 women and employed the same dosage of both iron and lactoferrin (520 mg daily vs. 100 mg twice daily). This 30 day trial actually found that lactoferrin outperformed ferrous sulfate by increasing values of hemoglobin and “total serum iron” to a greater extent. Once again, lactoferrin was superior in that it didn’t provoke adverse reactions. Based on the currently available evidence, a recent scientific review suggests that lactoferrin can be considered in certain cases of pregnancy related iron deficiency."
http://www.healthyfellow.com/309/lactoferrin-and-anemia/



Inhibited hyphal growth in azole resistant strains of Candida
http://www.ncbi.nlm.nih.gov/pubmed/9660988



Lactoferrin peptide synergistic with fluconazole
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC149030/?tool=pmcentrez



Lactoferrin was synergistic with amphotericin and fluconazole
http://www.ncbi.nlm.nih.gov/pubmed/10543740



Adding lactoferrin to polyene antifungals (nystatin, amphotericin) was not as effective as the azoles.
http://www.ncbi.nlm.nih.gov/pubmed/8985937



It was found that TLF acted synergistically with amphotericin B and fluconazole against C. albicans.
http://www.ncbi.nlm.nih.gov/pubmed/18719181



"We conclude that a lactoferrin-containing mouthwash has fungistatic properties, may be fungicidal to C. krusei and may be a candidate for the treatment and prevention of oral and esophageal candidiasis."
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102251951.html



"Synergistic inhibitory effects on Candida growth were found for combinations of lactoferrin and fluconazole or amphotericin B, irrespective of the medium type and pH, or the addition of saliva."
http://www.ncbi.nlm.nih.gov/pubmed/12076264



This study showed that Blf increased IL-18 in intestinal epithelial cells.
http://www.ncbi.nlm.nih.gov/pubmed/11525597



In this study of mice, it was found feeding IL-18 restored TH1 immunity to Candida.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC101755/



This study provides more evidence of lactoferrin increasing intestinal immunity. Strongly increased CD4T helper cells in the small intestine.
http://www.ncbi.nlm.nih.gov/pubmed/11050473



Low levels of CD4 helper cells are associated with candidiasis.
http://www.naturalstandard.com/index-abstract.asp?create-abstract=/monographs...



Further evidence of the important role of CD4 in candidiasis.
http://www.ncbi.nlm.nih.gov/pubmed/11796605



"Hence, dietary rhLF is digested in the upper GI tract and does not reach the colon."
http://jn.nutrition.org/cgi/content/full/132/9/2597



"Another problem with Candida overgrowth is that it sticks to mucosal linings and spreads like a weed. A study with vaginal mucosal lining cells showed that lactoferrin not only significantly reduces Candida from sticking; it actually helps detach Candida if it has already latched on. This finding is likely to apply to other mucosal linings such as the lungs, sinuses, and digestive tract."
http://www.wellnessresources.com/tips/articles/lactoferrin_keeping_candida_fr...



"In a recent study, researchers have discovered a protein in human tears, mucus, sweat, and milk that blocks biofilms from growing. The protein lactoferrin discourages bacteria from clumping into biofilms. Lactoferrin stimulates 'twitching,' which causes the bacteria to wander around rather than form harmful clusters.
Pradeep K. Singh, of the University of Iowa College of Medicine in Iowa City, led the study that was published in Nature. He and colleagues hypothesize that lactoferrin's affinity for iron prohibits biofilm growth. Lactoferrin acts as a signal: It tells bacteria that iron is in short supply, an essential nutrient for biofilms. Therefore, the bacteria go elsewhere to build their elaborate homes."
http://www.genomenewsnetwork.org/articles/06_02/biofilms.shtml



Biotene (contains lactoferrin) plus Sporanox cured unresponsive oral thrush
http://journals.lww.com/aidsonline/Fulltext/2000/10200/Complete_response_of_s...



"We conclude that after oral administration, substantial amounts of apoLF and holoLF survive gastric transit."
http://answers.google.com/answers/threadview/id/451855.html



"When fighting infection or a specific condition, take a dosage of one capsule three times per day (750mg total) ; for maintenance take one capsule per day."
http://www.gutdoctor.com/products/30



"As a food supplement or for maintenance, Apo-Lactoferrin is most often advised in dosage from 250 - 500 mg per day. For therapeutic effects, Apo-Lactoferrin powder is given at high dosage of 1-3 grams per day preferably divided in 3 applications per day. Substantially higher dosage is sometimes advised for body builders and athletes (3-6 grams) or for treating hepatitis C or a disorder related to nutritional deficiency (2-4 grams)"
http://www.benseng.com/product/product-lactoferrine-apo-en.html



This is the study that looked at bLF increasing IL-18.
“.... doses of 100 or 300 mg/kg/day for seven successive days”
http://www.ncbi.nlm.nih.gov/pubmed/11525597



This trial used 1.8g-3.6g/day to treat hepatitis C.
http://www.ncbi.nlm.nih.gov/pubmed/10363572



Effective in treating H. pylori in humans. The bLF group received bLF tablets at a dosage of 200 mg b.i.d. (400mg/day) for a period of 12 weeks. The study showed significant inhibition of H. Pylori, compared to placebo, however only 32% responded. This suggests to me that 400mg/day was sub optimal, and that a higher dose would have achieved better results.
http://www.ncbi.nlm.nih.gov/pubmed/16369731



"Improvement of immune regulation calls for a dosage ranging from 200 to 400 milligrams. I haven’t run across doses higher than 1400 milligrams a day except in cases where a doctor was going after an actual infection. One interesting example of this was with a patient suffering from gastritis that was likely caused by H-pylori bacteria. After a course of treatment with high-dose lactoferrin, there was a complete clearance of all symptoms. While we haven’t seen any problems with taking larger doses, one animal study using very large doses led to some damage to the gastro mucosa. In terms of human feed-back, lactoferrin is a relatively benign substance, though if one takes too much it could lead to some diarrhea or a drop in energy. Reduce the dose if this occurs.
http://intelegen.com/ImmuneSystem/lactoferrin_coordinating_the_hum.htm



"At what time of the day should these be taken? Lactoferrin is a physiological replenishment. It can be taken anytime of the day. Is it better to take them with food? If convenient - yes."
http://www.ybhurtn.biz/Lactoferrin_Gold_1.php



"For maximum absorption, lactoferrin should be taken before meals or on an empty stomach."
http://www.medhelp.org/user_journals/show/14682/Lactoferrin



".... with or without meals."
http://www.health-marketplace.com/Lactoferrin.htm



"between meals"
http://www3.shopping.com/xPO-Ecological-Formulas-Lactoferrin-100-mg-60-capsul...



"Capsules should be taken on an empty stomach with a large glass of tepid water (approximately 300ml)."
http://www.gutdoctor.com/products/30



"taken in one dose at bedtime. This is the most common time to take this for immune regulation purposes and will not interfere with sleep in any way."
http://intelegen.com/ImmuneSystem/lactoferrin_coordinating_the_hum.htm



Summary:
Only apo-lactoferrin is effective against Candida. Synergistic with other antifungals. Fungicidal (not fungistatic) against most (all?) strains of Candida, including the hard to treat C. krusei. Prevents Candida turning hyphal. Prevents biofilms from forming and may break down existing biofilms. Detaches Candida from mucosal linings. Stimulates Th1 immune response (IL-18, CD4) against Candida in small intestine, potentially not only helping kill off Candida, but preventing future relapse (if you keep taking lactoferrin). It is effective in treating H. pylori gastritis. It kills a number of pathogenic bacteria, viruses and parasites. Stimulates growth of good bacteria such as Lactobacilli and Bifidobacteria. It does not contain casein so will not cause a milk allergy. Lots of in vitro laboratory research, and in vivo with animals, but very little data on use with humans, especially with intestinal candidiasis, so unfortunately it is still unproven for that use. The effective dosage for treating intestinal Candida is unknown. There is also conflicting information on when to take doses.

Bottom line:
Although it's not proven to cure intestinal candidiasis, I think apo-lactoferrin has a big potential upside and no apparent downside. I get a big die-off from only one capsule (300mg) of apo-lactoferrin. I intend gradually increasing to 8 caps/day. This will mean I will be ingesting 2.4g of lactoferrin a day, which is the same amount of lactoferrin the average breast fed newborn baby consumes.
"